Is Your Medical Aid All it was Cracked Up to Be?

July 20, 2015

In May 2015 an important seminar took place at the Section 27 offices in Braamfontein. And in the course of this meeting Tim Fish Hodgson posed an important question. He asked: “Are medical schemes all they are cracked up to be? Who is speaking for the patients at the Competition Commission’s Market inquiry into the Private Health Care Sector?”

This inquiry is to examine the competitiveness of this sector. It will also figure out how this relates to the quality and affordability of healthcare in South Africa. So if you’re a patient and do have something to say, make your voice heard now. Members could say if their medical aid was all it is cracked up to be.

For a long time, the public health sector has been easy prey for investigators with its glaring inadequacies mercilessly exposed. It’s about time the spotlight shone on private healthcare providers and their shortcomings addressed. And there are quite a number of shortcomings. One of these is how patients are kept in the dark about their health situation what it really costs them by doctors and medical schemes. This results in you, as a patient, being almost entirely at their mercy during treatment.

Is you medical aid all it was cracked up to be?

People tend to forget that at the end of the day a patient is a customer. But you are at a distinct disadvantage when you are sick and in need of attention. When you or an ailing dependent are in dire need of treatment, you don’t have the power of choice someone say, looking for a new pair of shoe, has. You are virtually dependent on the good graces of whichever healthcare facility you approach first.

But there are laws in place to protect patients as they seek medical help. Few know that the health sector is subject to the constitution, and in particular, Section 27 which talks about the right to health. This section places an obligation on anyone who ventures into the healthcare provision sector to accept the attendant moral and constitutional duties.

Tim Fish Hodgson and another lawyer, Sher-Muhammad Khan feel that the commission should hear the patients’ side of the healthcare story. The fact that healthcare is a demand and supply market like any other should not justify the suppression of the human stories of people seeking treatment. In fact, Khan and Hodgson, insisted, the patient should be at the centre of the inquiry. This, the pair said, does not appear in the 67 submissions presented to the commission. They wondered why patients and medical scheme members were not giving their input into an inquiry into private healthcare. Yet it is they who are at the centre of the industry.

Is your medical aid all it is cracked up to be?

This misnomer prompted the NGO called Section 27, fronted by the two lawyers, to collect all the patient experience stories they could gather. Many of the accounts they submitted showed how profiteering in the health sector led to injustices. A case was heard of a lady whose medical cover provider agreed to pay in full for her hip replacement but not for the procedure to implant it. This procedure is listed as a Prescribed Minimum Benefit (PMB). Many schemes are notorious for trying to wangle their way out of paying for PMBs.